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The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. -

Gross distal caries

From: Terry Pannkuk
To: roots
Sent: Tuesday, January 24, 2012 3:29 AM
Subject: [roots] Whatever it takes

This lower second molar presented with gross distal caries and 
difficult isolation challenges complicated by the patientís very 
narrow arch.   We talked about block out resin, Dycal, Oraseal,
and other strategies.  My strategy for this one was to send him 
to the oral surgeon and get the wisdom tooth out, during the
month interim with CH.

I also simplified the process by packing the distal canal only 
a couple weeks ago, then scheduling a separate appointment to 
pack the mesial required time and were more complex with very 
difficult access and curvatures.  Today the distal wall of Cavit
was nicely sealed and I didnít have to take the temp out on the
distal aspect making it a very simple appointment.The previous 
appointment was simple too because the Dycal seal on the distal 
held up perfectly for the shorter amount of time required to pack 
just the distal. I cleaned and shaped to the RT, but fit the cone 
to the blotting point at 24 mm on this case, the working length 
was 24.75mm.  The puff  pretty much shows that.(small as practical)

Multiple advantages dividing the visits up:

1. More irrigant action, more recapitulations.

2. Better isolation and asepsis.

3. Patientís jaw less fatigued.

Therefore the overall result is better

Fitting a cone is an important diligent step which insures success 
in numerous ways, not necessarily related to the quality of obturation.  
Controlling the case aseptically with a diligent strategy
for access, C & S, interim temporization, and obturation from start
to finish is the key - Terry

Gross distal caries

Gross distal caries


Anastomosing Laterals

Calcified canals

Pulp chamber

Calcified molar

Ominous Lesion

Instrumenting MB2



Buccal caries

Recent recall


Cast post cores

Severe pain

Perio pocket

Not much calcified

Hess anatomy

3 palatal POE

Crap endo

Implant algorithm


Long term recall


Nerve proximity

Tooth #15

Psicologic condition

Fractured central

Radicular root

Wave lower molar


ECIR recall

Stainless steel band


Microscope dentistry

Complex root canal

Upper premolar

Scope bracket

Thermafilth abuse

Retreatment failure

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